Use of cyclosporine in children and adolescents with moderate to severe atopic dermatitis: clinical experience in a tertiary Hospital

topic dermatitis (AD) is one of the most common deratoses in the pediatric age group, and its prevalence as increased in recent years worldwide.1 In a systematic eview, the prevalence reached 22.6% in children and up to 7% in adolescents and adults.2 A dysfunctional skin barrier, an inflammatory response ith a predominance of the Th2 pattern and altered microTable 1 Preand post-treatment SCORAD descriptive values.

Sixteen patients were included: 9 (56.3%) female and 7 (43.8%) male individuals. Fourteen (87.5%) had been admitted to the hospital at least once and 6.3% were admitted six times due to secondary bacterial and viral skin infections, which could be related to treatment with cyclosporine. Table 1 depicts the pre-and post-treatment SCORAD scores with cyclosporine treatment, showing a significant decrease in the SCORAD scores after treatment (p = 0.001). Fig. 1 shows the SCORAD mean and standard deviation values before and after the use of cyclosporine. Treatment duration ranged from one to 30 months (mean of 11.73 months with a standard deviation of 7.06 months and median of 11 months). Three patients (18.8%) discontinued treatment: one due to bacterial skin infection, one due to a liver transplant because of autoimmune liver disease, unrelated to cyclosporine use, and another for an unknown reason. Seven patients (43.8%) had side effects: four (25%) had hypertrichosis and three (18.7%) had bacterial and viral skin infections. Potentially severe adverse effects, such as increased serum creatinine and isolated arterial hypertension, more common in adults, 7,8 were not observed in the present study.
Harper et al. described transient alterations in serum creatinine levels in four children, which regressed spontaneously or soon after the reduction in the cyclosporine dose. Although side effects are more common in adults, monitoring of blood pressure and renal function should be performed when prescribing cyclosporine to the pediatric population. 6,7 The SCORAD percentage variation delta (post value ---pre value/pre value*100) ranges from -76.11% to 11.18% (mean of -43.71% with a standard deviation value of 19.95% and median of -49.28%).
There was a reduction of more than 30% in SCORAD scores in 75% of patients treated with cyclosporine A, which demonstrates therapeutic efficacy. Similar data have been reported in the literature. 7,9,10 There was no significant correlation between treatment duration and the SCORAD variation delta (Spearman correlation coefficient: r = 0.035; p = 0.896).
The groups with and without side effects did not show a significant difference in relation to the SCORAD variation delta.
The occurrence of malignant neoplasms (lymphomas and squamous cell carcinoma), may be associated with the use of high doses of cyclosporine in transplant patients, and also with the use of cyclosporine in patients with psoriasis that were previously treated with methotrexate and/or phototherapy. 8 No case of malignant neoplasm, associated with the use of cyclosporine, was observed in this study or any other similar in the literature. 8 Among the comorbidities present before treatment with cyclosporine, depression, diagnosed by a psychiatrist, was found in 43.8% of the patients.
Although more frequent in adult patients with moderate and severe AD, children and adolescents with atopic dermatitis have shown severe depression and other psychiatric disorders. 5 More studies with the pediatric population are required to elucidate the correlation between psychiatric diseases and atopic dermatitis.
The use of cyclosporine A in the treatment of moderate and severe forms of AD in adults is effective and welldocumented in the literature. There is a lack of studies on the pediatric population in Brazil.
The present study allowed the authors to conclude that treatment with cyclosporine was effective and well tolerated by children and adolescents with moderate/severe AD, at a dose of 3 to 5 mg/Kg/day.

Financial support
None declared.